The DOI matches its Crossref record; 54 of the 54 references it cites were found in a registry or an index.
Efficacy of an Internet-Based Behavioral Intervention for Adults With Insomnia
Open accessAbstract
CONTEXT: Insomnia is a major health problem with significant psychological, health, and economic consequences. However, availability of one of the most effective insomnia treatments, cognitive behavioral therapy, is significantly limited. The Internet may be a key conduit for delivering this intervention. OBJECTIVE: To evaluate the efficacy of a structured behavioral Internet intervention for adults with insomnia. DESIGN, SETTING, AND PARTICIPANTS: Forty-five adults were randomly assigned to an Internet intervention (n = 22) or wait-list control group (n = 23). Forty-four eligible participants (mean [SD] age, 44.86 [11.03] years; 34 women) who had a history of sleep difficulties longer than 10 years on average (mean [SD], 10.59 [8.89] years) were included in the analyses. INTERVENTION: The Internet intervention is based on well-established face-to-face cognitive behavioral therapy incorporating the primary components of sleep restriction, stimulus control, sleep hygiene, cognitive restructuring, and relapse prevention. MAIN OUTCOME MEASURES: The Insomnia Severity Index and daily sleep diary data were used to determine changes in insomnia severity and the main sleep variables, including wake after sleep onset and sleep efficiency. RESULTS: Intention-to-treat analyses showed that scores on the Insomnia Severity Index significantly improved from 15.73 (95% confidence interval [CI], 14.07 to 17.39) to 6.59 (95% CI, 4.73 to 8.45) for the Internet group but did not change for the control group (16.27 [95% CI, 14.61 to 17.94] to 15.50 [95% CI, 13.64 to 17.36]) (F(1,42) = 29.64; P < .001). The Internet group maintained their gains at the 6-month follow-up. Internet participants also achieved significant decreases in wake after sleep onset (55% [95% CI, 34% to 76%]) and increases in sleep efficiency (16% [95% CI, 9% to 22%]) compared with the nonsignificant control group changes of wake after sleep onset (8% [95% CI, -17% to 33%) and sleep efficiency (3%; 95% CI, -4% to 9%). CONCLUSIONS: Participants who received the Internet intervention for insomnia significantly improved their sleep, whereas the control group did not have a significant change. The Internet appears to have considerable potential in delivering a structured behavioral program for insomnia. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00328250.
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“However, within this growing number of studies, the range of outcomes can vary from virtually no effect to effect sizes that are similar to face-to-face interventions.”
From Behavioral Intervention Technologies: Evidence review and recommendations for future research in mental health (2013) · cites this paper as [18]
In the citing paper
“Attrition and non-adherence can also range widely, from extremely high (>95% for standalone depression sites), modest (many anxiety sites), to minimal (insomnia), depending on the disorder and how participants were sampled or screened.”
From Behavioral Intervention Technologies: Evidence review and recommendations for future research in mental health (2013) · cites this paper as [18]
In the citing paper
“Standalone interventions have produced a wide range of outcomes, from small or nonsignificant (e.g. many depression sites, substance abuse) to moderate (some anxiety disorders) to fairly large (insomnia) (14, 15, 18, 25).”
From Behavioral Intervention Technologies: Evidence review and recommendations for future research in mental health (2013) · cites this paper as [18]
In the citing paper
“The efficacy of web-based intervention has been demonstrated by a large number of trials for a number of mental health problems, including depression, anxiety disorders, alcohol and substance abuse, and insomnia (14–18).”
From Behavioral Intervention Technologies: Evidence review and recommendations for future research in mental health (2013) · cites this paper as [18]
In the citing paper
“Although initial results are promising, further work is needed because many of the trials have been relatively small [44-47].”
From Web-Based Interventions for Behavior Change and Self-Management: Potential, Pitfalls, and Progress (2012) · cites this paper as [45]
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Citations
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Self-citationRecommendations for a standard research assessment of insomnia
Buysse, D. J., Ancoli-Israel, S., Edinger, J. D., Lichstein, K. L., & Morin, C. M. (2006) · Sleep · doi:10.1093/sleep/29.9.1155 · Cited by 1,206
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Cited by
Sorted by citations
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“These six meta-analyses focus on self-help CBT-I approaches (Ho et al., 2015; Van Straten and Cuijpers, 2009), or internet-based CBT-I, for example, the programmes ‘sleep healthy using the internet’ (SHUTi; Ritterband et al., 2009) or SLEEPIO (Espie et al., 2012).”
Qaseem, A., Kansagara, D., Forciea, M. A., Cooke, M., Denberg, T. D., & for the Clinical Guidelines Committee of the American College of Physicians* (2016) · Annals of Internal Medicine · doi:10.7326/m15-2175 · Cited by 1,965
“Improvements were seen across the various methods of CBT-I delivery, including in-person individual therapy (18, 24, 33, 35, 36), in-person group therapy (19, 20, 31), telephone-based modules (21), Web-based modules (17, 22, 23, 25), and self-help books (26, 29, 37); however, evidence was insufficient to determine the…”
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Self-citationDefining Internet-Supported Therapeutic Interventions
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“net; [17]), a CBT web-based program for insomnia, provides text, pictorial, animation, and audio formats.”
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“including depression, anxiety disorders, alcohol and substance abuse and insomnia [14–18].”
Metadata
- Authors
- Ritterband, L. M., Thorndike, F. P., Gonder-Frederick, L. A., Magee, J. C., Bailey, E. T., Saylor, D. K., & Morin, C. M.
- Affiliations
- University of Virginia Health System (US)
- ORCID
- Venue
- Archives of General Psychiatry
- Publisher
- American Medical Association (AMA)
- Published
- 2009-07-01
- Volume
- 66
- Issue
- 7
- Pages
- 692
- ISSN
- 0003-990X (ISSN-L)
- PMC
- PMC3723339
- OpenAlex
- W2126133436
- Cited by
- 482
- References
- 52
- Citations by year
- 2026: 19 · 2025: 18 · 2024: 25 · 2023: 28 · 2022: 28 · 2021: 26 · 2020: 23 · 2019: 24 · 2018: 31 · 2017: 31 · 2016: 30 · 2015: 44 · 2014: 28 · 2013: 33 · 2012: 33
- FWCI
- 39.71
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Archives of General Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Mental Health (R34 MH70805, R34MH070805)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Health Sciences › Medicine › Physiology (medical) › Obstructive Sleep Apnea Research
- Keywords
- insomnia, online intervention, cognitive behavioral therapy, sleep restriction, stimulus control, sleep hygiene, cognitive restructuring, relapse prevention, insomnia severity, wake after sleep onset, sleep efficiency, treatment efficacy, maintenance of treatment gains, waitlist control, follow-up outcomes, Insomnia Severity Index, sleep diary, cost-effectiveness, acceptability
- MeSH terms
- Adult, Feasibility Studies, Female, Follow-Up Studies, Humans, Sleep Initiation and Maintenance Disorders, Male, Middle Aged, Patient Education as Topic, Therapy, Computer-Assisted, Cognitive Behavioral Therapy, Treatment Outcome, Self Efficacy, Internet
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